AB0547 PLACENTAL ANGIOGENESIS MARKERS IN THE SCREENING FOR ADVERSE PREGNANCY OUTCOMES IN SLE AND APS
Authors: J. S. Brigger, A. Zbinden, L. Raio, F. Förger
Journal: Annals of the Rheumatic Diseases (2022)

Background Pregnancies in patients with systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS) are at risk for adverse pregnancy outcomes such as preeclampsia or placental insufficiency and prematurity. In these high-risk pregnancies, maternal serum concentration of the anti-angiogenic factor soluble Fms-like tyrosine kinase-1 (sFlt-1) and the pro-angiogenic factor placental growth factor (PlGF) can predict fetal growth restriction and preeclampsia (1-3). Objectives To evaluate the sFlt-1/PlGF ratio in routine assessment of singleton high-risk pregnancies in patients with SLE and APS. Methods Patients with SLE and APS that followed in our outpatient clinic were retrospectively analysed for their pregnancy course and outcomes. In these high-risk pregnancies, the sFlt-1/PlGF ratio was measured in the context of screening for preeclampsia and a ratio below 38 was applied to exclude preeclampsia. We compared the sFlT-1/PlGF ratio between patients with and without adverse pregnancy outcome. Adverse pregnancy outcome (APO) was defined as preeclampsia, preterm delivery and small for gestational age newborns. Results We analysed sFlt-1/PlGF ratios of 13 singleton pregnancies in 12 patients with SLE and/or APS (4 SLE, 6 SLE with APS or aPL, 2 obstetric APS). Low-dose aspirin was used in all but one pregnancy with de-novo obstetric APS. Low-molecular weight heparin was given in seven pregnancies. Adverse pregnancy outcome occurred in five pregnancies thereof two with preeclampsia. The median sFlt-1/PlGF ratio measured between gestational week 22 and 37 was higher in patients with APO (median 173, range 4 -1904) than in patients without APO (median 7.5, range 1-50) (P=0.03). The sFlt-1/PlGF ratio &gt; 38 was found in 6 pregnancies including two with preeclampsia. Highest sFlt-1/PlGF ratios were found in a case with severe intrauterine growth restriction without signs of preeclampsia (sFlt-1/PlGF=1940) and in a case with early preeclampsia &lt; week 34 (sFlt-1/PlGF=1187). In pregnancies with a sFlt-1/PlGF ratio &lt; 38 there were no signs of preeclampsia or intrauterine growth restriction. Conclusion The detection of a dysbalanced sFlt-1/PlGF ratio is clinically useful as it differentiates between pregnancies with adverse outcome and those without. More data are needed to further evaluate the predictive potential of these placental biomarkers in the first trimester and their usefulness for treatment adjustments in order to improve pregnancy outcome. References [1]Zeisler H, Llurba E, Chantraine F, Vatish M, Staff AC, Sennstrom M, et al. Predictive Value of the sFlt-1:PlGF Ratio in Women with Suspected Preeclampsia. The New England journal of medicine. 2016;374(1):13-22. [2]Umapathy A, Chamley LW, James JL. Reconciling the distinct roles of angiogenic/anti-angiogenic factors in the placenta and maternal circulation of normal and pathological pregnancies. Angiogenesis. 2020;23(2):105-17. [3]Kim MY, Buyon JP, Guerra MM, Rana S, Zhang D, Laskin CA, et al. Angiogenic factor imbalance early in pregnancy predicts adverse outcomes in patients with lupus and antiphospholipid antibodies: results of the PROMISSE study. American journal of obstetrics and gynecology. 2016;214(1):108 e1- e14. Disclosure of Interests Jasmin Simone Brigger: None declared, Astrid Zbinden: None declared, Luigi Raio Speakers bureau: Thermo Fischer, Frauke Förger Speakers bureau: UCB pharma, GSK, Consultant of: UCB pharma, GSK, Roche, Grant/research support from: UCB pharma, GSK